Rash of Chicken Pox Cases Raises Questions

Vaccine has drastically reduced cases and deaths. But will it leave some adults at risk?

Jay Weinstein was relieved when his son Mark — a Seven Locks Elementary first-grader — got chicken pox last spring.

More than a dozen Seven Locks students got the disease, characterized by red blisters covering the body, and Montgomery County Department of Health and Human Services officials said there were outbreaks in several other schools, including two reported cases in middle schools, although neither Health and Human Services nor Montgomery County Public Schools keeps precise records of chicken pox cases.

The sickness kept Mark out of school — and Weinstein home from work — for several days and then passed without incident, as most childhood chicken pox cases do.

“I just look at it kind of from a common sense point of view,” said Weinstein, part of a generation of adults for whom having the disease as a child was normal and even expected. “My son is totally fine now. You can’t find any trace of anything. It took about three or four days for the discomfort to go away.”

It’s good news, he said, because chicken pox cases in adults are much more severe, with higher hospitalization and mortality rates.

Adults like Weinstein and even many young people born in the 1980s and '90s who had chicken pox as a child are generally immune to the effects of the virus that causes the disease — varicella zoster — although in some cases the virus can lie dormant and crop up later in life as shingles, a painful nerve disease.

But in 1995 the Food and Drug Administration licensed a vaccine for chicken pox, and in the years following the vaccine has become mandatory for school entry in 44 states, with varying grade-level requirements. The vaccine is between 80 and 90 percent effective, and has drastically reduced both total instances of chicken pox nationally and national mortality rates as a result of the disease.

But Weinstein worries about that other 10-15 percent, who may reach adulthood still being susceptible and have to face the more serious consequences of an adult chicken pox case. For him, old ways are the best ways.

“That’s the way you did it in the old days. One kid got it in the neighborhood and a bunch of kids came over and got it over with,” he said.

“I DON’T THINK that’s a position that the medical community would support but it definitely is true that chicken pox is much more of a problem in the adult population than in the pediatric population,” said Irm Pichot, nurse administrator at Health and Human Services.

She said that since the introduction of the vaccine, Montgomery County has seen a decline in the number of chicken pox cases and that the reported cases have generally been milder than in earlier years.

Starting in September, the vaccine will be required for all children entering fourth grade and below.

Mona Marin, medical epidemiologist with the National Immunization program at the Centers for Disease Control in Atlanta, said that the vaccine has been a great success.

“We’ve had so far more than an 80 percent reduction in disease incidence” nationally, she said a 90 percent decrease in mortality among children ages 1-4 and an 85 percent decrease in overall child mortality due to chicken pox. Reported cases among vaccinated children are “much, much milder,” Marin said.

Before 1995, the disease affected roughly 4 million people annually.

As for concerns about having a segment of the adult population the coming decades that is susceptible because the vaccine was not effective, Marin said, “We know that we’ll have later an accumulation of susceptible adults …and we’re trying to find ways to avoid this accumulation,” but noted that thanks to the vaccine “there is less and less virus circulating so the opportunity for exposure will be less.”

The 85-90 percent effectiveness of the vaccine is consistent with expectations when the vaccine was licensed.

Following Food and Drug Administration approval of a vaccine, a national board of doctors and epidemiologists known as the Advisory Committee on Immunization Practices issues recommendations on dosing and usage guidelines.

The committee will meet next week to consider recommending a second dose of the vaccine for children. A vaccination series — similar to those used for diseases like hepatitis and tetanus — could increase the overall effectiveness.

Another proposal is to recommend that states require the vaccine for young people over a wider age range. Current requirements vary greatly, although some states are now requiring the vaccination for ages through high school and even college.

WEINSTEIN AND his family are most likely free and clear of worries about chicken pox.

“I’m glad that both my kids got it,” he said, since the future is uncertain for “that generation of kids that have had the vaccine but not had the actual disease.”

“Forecast 20 years from now you’re going to probably have 20 percent of the population walking around that’s not immune,” Weinstein said. “I thought it was something that at least the community should be thinking about.”

But for Marin, the greatest worry is that not enough children are getting the vaccination.

“We still have reports of deaths that occur due to chicken pox. As far as there is a vaccine that can present that, we see it as a problem,” she said. “Most of the deaths that were reported occurred among healthy people. This could have been prevented.”